An effort by the Trump administration to help patients battling sky-high surprise medical bills is earning high praise from patients, consumer advocates and even former health care advisers to President Obama.
Under a Department of Health and Human Services rule announced in November, hospitals would be required to post clear prices before patients receive medical treatments. That simple change – to mandate open and honest medical billing – is being described as “a potentially bold move” that would help lower healthcare costs and protect patients from toxic medical bills.
“Hospital prices are completely divorced from any underlying economic cost,” explains Terry Wilcox, executive director at Patients Rising, a national patient advocacy non-profit organization. “Prices are regularly several times higher than Medicare reimbursement rates. This is nothing short of price gouging. And it’s devastating ordinary American families across the country.”
Approximately one in five emergency room visits end with a surprise medical bill, in which insurance refuses to cover medical care at an in-network hospital.
“Hospitals can get away with this predatory pricing partially because they don’t tell customers how much they have to pay until after treatment, putting the patient in a powerless position,” Wilcox adds.
By law, hospitals are required to publish list prices for services and treatments. However, those rates don’t reflect massive kickbacks, discounts and rebates that hospitals negotiate with insurance companies. Beginning in 2021, the Trump administration’s rule would force hospitals to disclose what they really pay for services.
“It’s a game changer,” John Barkett, a former Obama administration official who helped write the Affordable Care Act, told the New York Times in November.
Surprise Medical Bills Devastate Families
Both insured and uninsured patients are being hit with surprise hospital bills that can drive families into debt and bankruptcy.
“For decades, hospitals, insurance companies, lobbyists and special interests have hidden prices from consumers, so they could drive up costs for you, and you had no idea what was happening,” President Trump said at a November press conference announcing the new rule. “You’d get bills that were unbelievable and you’d have no idea why.”
From a $24,000 bill for a broken arm to a $6,000 bill for two bags of saline and a couple of flu medications, outrageous medical bills have become commonplace. Patients are routinely charged several thousand dollars or more for basic treatments. There are stories of a $15,000 bill for a few tests to treat dizziness, a $22,000 bill for some basic treatment for stomach pains and a $2,000 bill for a feeding tube.
“Our goal is to give patients the knowledge they need about the real price of health care services,” President Trump said. “They’ll be able to check them, compare them, go to different locations, so they can shop for the highest-quality care at the lowest cost.”
Reporting by Kaiser Health News has detailed stories of patients being billed $48,000 bill for an allergy test, $17,850 for a urine test, and $15,076 for four tiny screws.
“Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,” patient Sherry Young said of a $115,527 hospital bill, which included the $15,076 line item for four tiny screws.
Hospitals File Lawsuit to Keep Prices Secret
“This plan is a major disruptor for the way that the industry works today,” explains John Nicolaou, a healthcare consultant.
Yet, patients may never benefit from this major disruption in healthcare pricing — if entrenched special interests prevail in their fight with the Trump administration.
Powerful industry players, led by the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals, filed a lawsuit in December to block the rule from taking effect.
“Hospitals are not free,” Michael Strazzella, a Beltway lobbyist who represents the health industry, said in defense of hospitals’ secret pricing agreements. “There are costs to running them so where is that administrative cost going to come from?”
Take Action: Share Your Outrageous Hospital Bill Story
- Do you have an outrageous hospital bill story to share? Are you being pursued by collectors with threats of having your credit ruined and your wages garnished? We want to hear from you here: https://patientsrisingnow.org/patient-stories/
- Become a patient advocate today: https://patientsrisingnow.org/get-involved-become-an-advocate/
